Provider Demographics
NPI:1811474679
Name:DEVEAU, TINA MARIE (MS, LMHC)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:MARIE
Last Name:DEVEAU
Suffix:
Gender:F
Credentials:MS, LMHC
Other - Prefix:
Other - First Name:TINA
Other - Middle Name:MARIE
Other - Last Name:VIOLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5826 WHISPER PINE DR
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748-1333
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5826 WHISPER PINE DR
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-1333
Practice Address - Country:US
Practice Address - Phone:407-572-5469
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-24
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH16159101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health